Analysis of Drug Compliance among Patients Suffering from Deep Vein Thrombosis

Objective: The objective of current research was to identify the compliance of commonly prescribed antithrombotic drug among patients who suffering from Deep Vein Thrombosis (DVT). Methodology: Descriptive cross-sectional research on adults with age of 18-65 years suffering from DVT were conducted on medicine department of Shaheed Mohtarma Benazir Bhutto Medical University Hospital of Larkana. Three hundred and forty eight DVT patients were consecutive selected during the period of six months from January 2021 to June 2021. Data of DVT patients Original Research Article Ali et al.; JPRI, 33(47A): 235-244, 2021; Article no.JPRI.74307 236 was collected by using standard proforma and analyzed with statistical package of social sciences (SPSS) version 25. Results: Majority of DVT patients evaluated during study period were male 237 (61.7%) patients and 147 (38.3%) DVT patients were female. Mean age of DVT patients was 43.78 ± 12.43 (18-65) years. Most of the patients were in age group of 51-65 years having 126 (32.8%) patients followed by 41-50 years having 104 (27.1%) patients, 31-40 years having 93 (24.2%) patients and 18-30 years having 61 (15.9%) patients. Majority of DVT patients were from urban areas 217 (56.5%) patients followed by rural areas 167 (43.5%) patients. Drug compliance in illiterate patients was 107 (36.1%). Drug compliance in indoor job patients was 102 (34.5%) whereas drug compliance in jobless patients was 59 (19.1%). Drug compliance in positive medication history was 207 (69.9%). Drug compliance in Hypertensive patients was 33 (11.1%) in congestive heart failure patients 27 (9.1%), in ischemic stroke 15 (5.1%). Whereas, the drug compliance among diabetes mellitus patients was 13 (4.4%). Overall drug compliance with antithrombotic drugs was reported in 296 (77.1%) DVT patients. Conclusion: Current research concludes that rate of drug compliance was high in patients of DVT with rivaroxaban followed by warfarin and heparin, whereas long duration of therapy, polypharmacy, side effects of therapy, cost of therapy, continuous monitoring, injectables, diet restrictions and ADRs of therapy were the most commonly reported factors of non-compliance.


INTRODUCTION
Thrombosis term is most commonly used for formation of abnormal mass from blood constituents in vascular system. If the process of thrombosis is observed in deep veins of body then it is known as deep vein thrombosis (DVT). In majority of cases deep vein thrombosis is formed in legs but it can also be observed either in veins of arms or in mesenteric veins or in cerebral veins [1][2][3].
It is a most common and important disease, considered as a part of venous thromboembolic disease (VTD). Venous thromboembolism diseases are considered as severe public health problem because of its significant association with increased rate of morbidity and mortality. It is enlisted as third common cause of mortality among cardiovascular diseases (CVDs) [3][4][5].
Deep venous thrombosis is disease of adults and rarely reported in children. Risk of deep venous thrombosis increased with increasing age (> 40 years). It is equally affecting the both male and female population. Different studies from United States of America (USA) reported that risk of development of deep vein thrombosis and its complications is higher in white peoples, in Africans and in Americans as compared to Asians and Hispanics [6][7][8] Approximately 70% patients of deep vein thrombosis are suffering from acute episode of disease in which symptoms disappears after successful treatment of the disease, whereas in remaining 30% patients of deep vein thrombosis are suffering with additional symptoms such as; breakdown of skin and painful ulcers. Besides that, patients who are experiencing their first episode of deep vein thrombosis are at a higher risk of subsequent episodes of disease throughout their lives [9][10][11][12][13]. In year 1856, triad of Virchow or Virchow's triad was described that explained the three different categories responsible for development of thrombosis. These three contributing factors of thrombosis formation are playing vital role in formation of thrombosis. First contributing factor of Virchow's triad was venous stasis, second factor was vessel wall injury and third last factor was hypercoagulability. The process of venous stasis is more significant among all three contributing factors but alone can't develop thrombus [14]. However, risk of thrombus formation increased, in existence of venous stasis along with vessel wall injury or hypercoagulability [15,16].

METHODOLOGY
Design of current hospitalbased study was descriptive cross-sectional.

Sample Size
For calculating sample size of research, online software of sample size calculation was used i.e., "OpenEpi". It is an open source software used for epidemiologic statistics in studies related to public health. In this research, population of Larkana (490,508) was used as prevalence for calculation of sample size. Calculated sample size for research was "348" with confidence interval (CI) of 95% and margin of error (MOE) 5%.
Online calculation of sample size obtained from Open Epi was described in Chart 1.

Data Collection Method
Before collection of data from patients of deep vein thrombosis, study approval was obtained from the Registrar of tertiary care hospital of Larkana. A specially designed questionnaire was used for interviewing enrolled patients and for collection of data.
At the end of interview, each patient was properly counseled about the appropriate use of medications in order to increase the compliance with medications and decrease the failure of therapy.

Statistical Analysis
Collected data was interpreted with latest version 25.0 of SPSS.

Overall Drug Compliance
Overall drug compliance with all three selected drugs were present in 296 (77.1%) patients and non-compliance was present in 88 (22.9%) patients.

Drug Compliance with Resident of DVT Patients
Drug compliance in rural area patients was 132 (44.6%) and in urban area patients was 164 (55.4%). Drug non-compliance in rural area patients was 35 (39.8%) and in urban area patients was 53 (60.2%).

Drug Compliance with Medication History of DVT Patients
Drug compliance in positive medication history patients was 207 (69.9%) and in without medication history patients was 56 (63.6%). Drug non-compliance in positive medication history patients was 56 (63.6%) and in without medication history patients was 32 (36.4%).

Drug Compliance with Hypertension in DVT Patients
Drug compliance in hypertensive patients was 33 (11.1%) and in non-hypertensive patients was 263 (88.9%). Drug non-compliance in hypertensive patients was 11 (12.5%) and in non-hypertensive patients was 77 (87.5%).

Drug Compliance with CHF in DVT Patients
Drug compliance in CHF patients was 27 (9.1%) and in non-CHF patients was 269 (90.9%). Drug non-compliance in CHF patients was 4 (4.5%) and in non-CHF patients was 84 (95.5%).

Drug Compliance with is in DVT Patients
Drug compliance in IS patients was 15 (5.1%) and in non-IS patients was 281 (94.9%). Drug non-compliance in IS patients was 7 (8.0%) and in non-IS patients was 81 (92.0%).

Drug Compliance with DM in DVT Patients
Drug compliance in DM patients was 13 (4.4%) and in non-DM patients was 283 (95.6%). Drug non-compliance in DM patients was 4 (4.5%) and in non-DM patients was 84 (95.5%).   [19]. Both Pakistani studies are reporting the higher prevalence of illiteracy in DVT patients.
In current research hypertension was the most commonly reported comorbidity in 44 (11.5%) DVT patients, followed by congestive heart failure in 31 (8.1%) DVT patients, ischemic stroke in 22 (5.7%) DVT patients and diabetes mellitus in 17 (4.4%) DVT patients. A similar Pakistani study by Ahmad, T., et al., reported the hypertension in 9.52% DVT patients, ischemic heart disease in 4.76% DVT patients and DM in 3.84% DVT patients [20]. Another study by Kang, J. M., et al., reported the hypertension in 33.15% DVT patients, DM in 14.3% DVT patients, ischemic heart disease in 3% DVT patients [23]. Another study by Demelo-Rodríguez, P., et al., also reported the hypertension in 43.2% DVT patients, DM in 11.7% DVT patients and ischemic heart disease in 7.2% DVT patients [24]. All studies are reporting the hypertension, diabetes mellitus, and ischemic stroke as a major risk factor for DVT.
In current research overall drug compliance with antithrombotic drugs was reported in 296 (77.1%) DVT patients, A similar study by Kang, J. M., et al., reported the overall drug compliance 93.8% with antithrombotic drugs [23].

CONCLUSION
Current research conclude that rate of DVT is high in male patients as compared to female patients. DVT is a disease of elder age. Its rate is increasing with increasing age and especially age > 60 years that increases the risk of complications and makes difficult management of DVT. Approximately one third reported patients of DVT were uneducated or illiterate that increases the risk of non-compliance with DVT therapy. Approximately seventy percent of DVT patients reported the history of medications and forty five percent reports the family history of DVT. Most commonly reported comorbidity in DVT patients was hypertension followed by congestive heart failure, ischemic stroke and diabetes mellitus. Overall drug compliance with antithrombotic drugs was approximately seventy seven percent in DVT patients.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard guideline Patient's consent and ethical approval has been collected and preserved by the authors.